Do you know what it takes to keep your heart healthy? It’s important knowledge to have: Heart disease is still the leading cause of death in the United States, according to the Centers for Disease Control and Prevention. But the most common type, the hardening and narrowing of arteries known as atherosclerosis, could be as much as 90% preventable, says Erin D. Michos, MD. She’s the director of women’s cardiovascular health and an associate professor of medicine at Johns Hopkins University.

The more you know about your heart, the better you’re able to spot a problem. “It’s never too late to start treatment, but it’s much more effective if prevention starts earlier in life,” says Dr. Michos.

Test your heart smarts with this quiz. See if you can choose correctly before scrolling down to see the answer.

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1. What’s the recommended amount of weekly aerobic exercise you need to reduce your risk of heart disease?

A. 20 minutes of any exercise

B. 150 minutes of moderate exercise

C. 30 minutes of vigorous exercise

D. 180 minutes of vigorous exercise

Answer: B

Any exercise is better than none, of course. But according to government guidelines, you should get 150 to 300 minutes of moderate aerobic activity a week. If you exercise hard, you can cut that time in half: The recommendation for vigorous exercise is just 75 to 150 minutes a week.

Moderate exercise doesn’t have to be complicated. Grab a friend and take a stroll. “Walking is really the best exercise for most people, especially those who’ve been sedentary, because it uses the large muscles of your body,” says Nathan D. Wong, PhD. He’s a professor and director of the heart disease prevention program at the University of California at Irvine.

You can get your exercise bit by bit throughout the day. Wong suggests parking at the back of the parking lot, for example, so you have to walk more. And if you want vigorous exercise, just amp up your regular activity. Instead of walking, jog or run.

Now, how does exercise improve your heart health? It upgrades just about every system in your body, says Wong. “Physical activity has a positive effect not only on weight but also on muscle tone,” he says. “That has a direct impact on insulin sensitivity, reducing your risk of diabetes and improving your lipids to raise your protective HDL cholesterol.” But that’s not all: “Physical activity lowers levels of inflammation, which is a major contributor to heart disease in so many different ways,” he says.

2. What is the most common sign of a heart attack?

A. Tingling spine

B. Speeding pulse

C. Agonizing chest pain

D. Chest discomfort

Answer: D

If you guessed chest pain (C), give yourself partial credit. Discomfort, though, is the most common symptom. “It may not be pain,” says Dr. Michos. “It can be a pressure, squeezing, heaviness or pinching.” The feeling might spread from your chest to your jaw, throat, arm or back. It might even feel like heartburn.

Other symptoms to watch for include shortness of breath, unexplainable sweating or fatigue, says Dr. Michos. Women are more likely to have multiple symptoms. Those other symptoms can be distracting [from the true cause of heart attack],” says Dr. Michos. So women are more likely to chalk it up to indigestion, stress or anxiety.

It’s important to be aware of these heart attack symptoms even if you feel healthy. While the majority of heart attacks are in people with risk factors such as high blood pressure and high cholesterol, they sometimes happen in people with no warning signs. For example, a type of heart attack called spontaneous coronary artery dissection can affect young people, mainly women, who have no traditional risk factors, says Dr. Michos. This occurs when a heart artery tears, often due to a predisposition from some unknown genetic risk factor and triggered by a stressful event.

3. What nutrient does the most to improve heart health?

A. Fiber

B. Protein

C. Saturated fat

D. Antioxidants

Answer: A

Fruits and vegetables, whole grains, legumes and nuts are all foods you should be eating every day. They’re high in fiber and low in saturated fat, says Dr. Michos, which is a good combination for reducing cholesterol. Fish, while it doesn’t have fiber, is also a great food for heart health, she says. It has healthy fats, which can benefit your cardiovascular system.

“These foods align well with a Mediterranean-style diet or a DASH-style diet,” says Dr. Michos. (DASH stands for Dietary Approaches to Stop Hypertension.) “And if you drop the fish, the foods also align with a healthy vegetarian or a vegan plant-based diet.”

As for foods to avoid, Dr. Michos suggests steering clear of processed meats, refined carbs, sweetened drinks and anything with trans fats. These can all raise your heart disease risk.

4. How many heart disease deaths are linked to cigarette smoking?

A. 1 in 20

B. 1 in 10

C. 1 in 5

D. 1 in 3

Answer: D

Smoking cigarettes is just about the worst thing you can do for your body. It raises your risk of lung cancer by a factor of 15 to 30, according to CDC data. And it damages the lining of your blood vessels, which raises your risk for many heart problems.

The good news: Within just a year of quitting, you can cut your heart disease risk in half. If you’re ready to kick the habit, check out this guide to quitting cigarettes.

5. Which of these is the healthiest blood pressure?

A. 30/60 mmHg (millimeters of mercury)

B. 115/75 mmHg

C. 180/200 mmHg

D. 220/320 mmHg

Answer: B

You want your blood pressure to stay under 120/80. Anything below 90/60 is generally considered too low, according to the Mayo Clinic. But the bigger problem is blood pressure that’s too high. That’s a major risk factor for heart attacks, heart failure and stroke.

If your top number (systolic pressure) is between 120 and 129 and your bottom number (diastolic pressure) is under 80, that’s “elevated” blood pressure. People in this category are likely to develop high blood pressure, also called hypertension, unless they take steps to control it.

Stage 1 of high blood pressure is 130–139 over 80–89, says Dr. Michos. If you’re in this stage and have an otherwise low risk of heart disease, sometimes lifestyle changes are enough to lower it. Start by limiting alcohol, cutting down on salt in your diet, exercising more and losing weight (if you’re overweight).

“But if patients already have heart disease, kidney disease or diabetes, and their blood pressure stays above 130/80 on 3 or more occasions, then we do recommend drug therapy in addition to lifestyle changes,” says Dr. Michos.

Your doctor will probably recommend medication if you have stage 2 high blood pressure, defined as 140/90 and above. Possible prescriptions include:

  • a thiazide diuretic, such as chlorthalidone
  • a calcium channel blocker, such as amlodipine
  • an angiotensin-converting enzyme inhibitor, such as enalapril
  • an angiotensin receptor blocker, such as losartan

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6. How does type 2 diabetes affect heart health?

A. It doesn’t. The conditions are unrelated.

B. Nobody knows for sure.

C. It increases the risk of dying from cardiovascular disease.

D. It has a small, indirect effect, since it makes it harder to exercise.

Answer: C

In a recent Journal of the American Heart Association study, researchers analyzed 8 years’ worth of data from nearly a million people. They concluded that diabetes was associated with an 18 percent increase in dying from cardiovascular disease. “The first thing people need to know about diabetes is that it’s not just a blood sugar problem,” says Wong. “It’s a cardiovascular problem.”

If you have type 2 diabetes, work with your doctor to control your blood sugar and hemoglobin A1C, another diabetes indicator, along with your cholesterol and blood pressure. Fewer than 2 in 10 people with type 2 diabetes have all these factors under control, Wong’s research shows.

Fortunately, some medications, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors (canagliflozin, dapagliflozin and empagliflozin) and glucagon-like peptide-1 receptor agonists (such as oral semaglutide), can reduce both your blood sugar and your risk of cardiovascular disease, says Wong.

7. Which of these is considered a healthy total cholesterol count?

A. 30 milligrams per deciliter (mg/dL)

B. 60 mg/dL

C. 150 mg/dL

D. 350 mg/dL

Answer: C

For adults, total cholesterol of 125 to 200 is considered healthy, according to the Cleveland Clinic. But within that number are other details to know about, such as your LDL (bad) cholesterol and HDL (good) cholesterol levels. Knowing these can help you get a big picture of your risk. So it’s important to work with a doctor to evaluate your cholesterol.

Should you take a statin medication if your cholesterol is too high? Your doctor will consider other risk factors alongside your cholesterol profile to help you answer that question. Statin medications do more than just lower cholesterol, says Dr. Michos. She thinks of them as prevention medications. “They can help shrink plaque, decrease plaque inflammation and make plaque more stable so that it is less likely to rupture,” she says. (Learn about the side effects of statins here.)

People with very high cholesterol due to a genetic condition, or high-risk patients who can’t reduce their cholesterol enough with statins alone, may be prescribed a special monoclonal antibody treatment called PCSK9 inhibitors, Dr. Michos says. These antibodies block a protein that’s involved in degrading the receptor for LDL cholesterol in the liver. As a result, more LDL receptors on the surface of your liver are available to remove the bad LDL circulating in your bloodstream. In a recent study, a monoclonal antibody called evinacumab cut LDL cholesterol levels by more than 50% in a high-risk population.

8. How does obesity affect blood pressure?

A. It slightly lowers it.

B. It has no effect.

C. It increases the risk of high blood pressure, but only for men.

D. It increases the risk of high blood pressure for men and women of any age.

Answer: D

There is much research linking obesity with high blood pressure and heart disease. In one study of nearly 20,000 Canadians, researchers found that hypertension in men and women increased with increasing body mass index (BMI), especially among 18- to 34-year-olds. In the younger adults, men and women with BMIs above 30 had 5 times more hypertension than people with BMIs under 20.

A 2019 review from Diabetology & Metabolic Syndrome explains that excess body fat increases inflammation, raises blood sugar, damages the lining of blood vessels and throws off the balance of hormones that keep the cardiovascular system in check.

But research also shows that any weight loss can be helpful. In one study, obese people who lost 5% to 10% of their body weight had measurable improvements in blood sugar, total cholesterol, LDL cholesterol and triglycerides, a type of fat that may contribute to hardening of the arteries or thickening of the artery walls. And the benefits were greater in people who lost even more weight. If you’re struggling with weight, talk with your doctor about your options.

9. Can pregnancy complications increase a woman’s risk of heart trouble later in life?

A. Yes

B. No

Answer: A

People are often surprised to learn that a history of preeclampsia, gestational diabetes or preterm delivery is associated with an increased risk for heart disease later in life, says Dr. Michos.

If you’ve had any of these complications, you should be extra vigilant about tracking your heart health. “I recommend that all doctors consider their patients’ reproductive history, which may influence their heart health, and ask women about prior pregnancies,” says Dr. Michos.

10. Which of these is considered an ideal resting heart rate?

A. 30 beats per minute (bpm)

B. 60 bpm

C. 90 bpm

D. 120 bpm

Answer: B and C

For most adults, 60 to 100 beats per minute is a normal resting heart rate, the American Heart Association indicates. “But there’s so much variation from person to person,” Dr. Michos says. Women tend to have faster heart rates than men. This isn’t necessarily a problem, as long as the reason is exercise and not a health condition.

The simplest way to find your heart rate is to count your pulse for 30 seconds and multiply the result by 2. Many fitness trackers also have monitors, or you can use one that straps to your chest. But don’t compare your heart rate to a friend’s. Instead, see how your own rate changes over time. With exercise, you should see the number start ticking down. “As people get more active, their heart becomes more efficient and their resting heart rate lowers,” says Dr. Michos.

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Additional sources
Heart disease is the leading cause of death in the U.S.: Centers for Disease Control and Prevention
Lifestyle factors to reduce heart-disease risk: The American Heart Association
Risk factor control in people with Type 2 diabetes: The American Journal of Cardiology (2019).Control of Cardiovascular Risk Factors Among US Adults with Type 2 Diabetes with and Without Cardiovascular Disease.”
Weight loss to reduce heart risk: Translational Behavioral Medicine (2016). “Effects on Cardiovascular Risk Factors of Weight Losses Limited to 5–10%.”
Monoclonal antibodies can cut LDL cholesterol by 50%: New England Journal of Medicine (2020). “Evinacumab in Patients with Refractory Hypercholesterolemia.”
Obesity and hypertension review: Annals of Translational Medicine (2017). “Association of Obesity with Hypertension.”
Smoking and lung cancer risk: Centers for Disease Control and Prevention
Low blood pressure: Mayo Clinic
Association of obesity with other cardiovascular risk factors, specifically blood pressure: The Canadian Medical Association Journal. “Risk Factor Correlates of Body Mass Index. Canadian Heart Health Surveys Research Group.”
What cholesterol numbers mean: Cleveland Clinic
Obesity and heart risk: Diabetology & Metabolic Syndrome (2019). “Cardiovascular Risk and Obesity.”
Prescription fish oil: The New England Journal of Medicine (2019). “Cardiovascular Risk Reduction With Icosapent Ethyl for Hypertriglyceridemia.”